Abstract:

OBJECTIVE: The objective was to investigate the effect and feasibility of low-intensity extracorporeal shockwave therapy (LI-ESWT) as a treatment for erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (RP).

MATERIALS AND METHODS: Patients who had undergone robot-assisted bilateral nerve-sparing RP more than a year before entering this pilot study, had no preoperative ED and were suffering from mild to severe postoperative ED were invited to participate. Six treatments were given over a 6 week period, using the Duolith® SD1 T-Top machine. The effect of the treatment was evaluated 1 month (t1) and 1 year (t2) after the final treatment. The main outcome measure was changes in the five-item International Index of Erectile Function (IIEF-5) scores.

RESULTS: Eighteen patients were included in the study. However, two patients breached the protocol and consequently 16 patients were included in the analysis at t1 and 15 patients were included in the analysis at t2. At baseline the median age was 62 years (range 51 to 70 years) and the median time since surgery was 24 months (range 12 to 54 months). The median preoperative IIEF-5 score was 25 (range 22 to 25) and the median baseline IIEF-5 score was 9.5 (range 5 to 20). The median change in IIEF-5 scores was +3.5 (range -1 to 8; p = 0.0049) and +1 (range -3 to 14; p = 0.046) at t1 and t2, respectively. No severe side-effects were reported.

CONCLUSIONS: LI-ESWT may improve erectile function after bilateral nerve-sparing RP. Based on these results, further studies in patients with ED after nerve-sparing RP are justified.

Scand J Urol. 2015 Oct 23:1-5. [Epub ahead of print]

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Comments
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This preliminary report of low intensity ESWT with the aim of improving erectile function after radical prostatectomy is slightly promising. The patients in this pilot study were given two ESWT sessions every other week during six weeks (that is totally 6 treatment sessions). The evaluation after one month showed a positive effect, whereas the effect on erectile function after 1 year apparently was marginal. My own interpretation of this result is that in order to get a more permanent effect, a different treatment protocol is necessary.

This preliminary report of low intensity ESWT with the aim of improving erectile function after radical prostatectomy is slightly promising. The patients in this pilot study were given two ESWT sessions every other week during six weeks (that is totally 6 treatment sessions). The evaluation after one month showed a positive effect, whereas the effect on erectile function after 1 year apparently was marginal. My own interpretation of this result is that in order to get a more permanent effect, a different treatment protocol is necessary.